Gingiva

"Gums" redirects here. For other uses, see Gum (disambiguation).

Gingiva
Cross-section of a tooth with visible gums, or gingiva
Gray's	subject #242 1112
MeSH	Gingiva
Code	TA A05.1.01.108 TA A03.1.03.003 TA A03.1.03.004

The gingiva (sing. and plur.: gingiva), or gums, consists of the mucosal tissue that lies over the mandible and maxilla inside the mouth.

General description

Gingiva are part of the soft tissue lining of the mouth. They surround the teeth and provide a seal around them. Compared with the soft tissue linings of the lips and cheeks, most of the gingiva are tightly bound to the underlying bone which helps resist the friction of food passing over them. Healthy gingiva are usually coral pink, but may contain physiologic pigmentation. Changes in color, particularly increased redness, together with edema and an increased tendency to bleed, suggest an inflammation that is possibly due to the accumulation of bacterial plaque.

A diagram of the periodontium. A, crown of the tooth, covered by enamel. B, root of the tooth, covered by cementum. C, alveolar bone. D, subepithelial connective tissue. E, oral epithelium. F, free gingival margin. G, gingival sulcus. H, principal gingival fibers. I, alveolar crest fibers of the PDL. J, horizontal fibers of the PDL. K, oblique fibers of the PDL.

Macroscopic features of gingiva

The gingiva is divided anatomically into marginal, attached and interdental areas.

Marginal gingiva

The marginal gingiva is the terminal edge of gingiva surrounding the teeth in collar like fashion. In about half of individuals, it is demarcated from the adjacent, attached gingiva by a shallow linear depression, the free gingival groove. Usually about 1 mm wide, it forms the soft tissue wall of the gingival sulcus. The marginal gingiva is supported and stabilized by the gingival fibers.

Attached gingiva

The attached gingiva is continuous with the marginal gingiva. It is firm, resilient, and tightly bound to the underlying periosteum of alveolar bone. The facial aspect of the attached gingiva extends to the relatively loose and movable alveolar mucosa, from which it is demarcated by the mucogingival junction. Attached gingiva may present with surface stippling.

Interdental gingiva

The interdental gingiva occupies the gingival embrasure, which is the interproximal space beneath the area of tooth contact. The interdental gingiva can be pyramidal or have a "col" shape.Attached gingiva is resistant to masticatory forces and always keratinised.

Diseases of the gingiva

The gingival cavity microecosystem, fueled by food residues and saliva, can support the growth of many microorganisms, of which some can be injurious to health. Improper or insufficient oral hygiene can thus lead to many gingival and periodontal disorders, including gingivitis or pyorrhea, which are major causes for tooth failure. Recent studies have also shown that Anabolic steroids are also closely associated with gingival enlargement requiring a gingivectomy for many cases. Gingival recession is when there is an apical movement of the gingival margin away from the biting (occlusal) surface.^[1] It may indicate an underlying inflammation such as periodontitis^[2] or pyorrhea,^[2] a pocket formation, dry mouth^[2] or displacement of the marginal gingivae away from the tooth by mechanical (such as brushing),^[2] chemical, or surgical means.^[3] Gingival retraction, in turn, may expose the dental neck and leave it vulnerable to the action of external stimuli, and may cause root sensitivity.^[2]

Characteristics of healthy gingiva

Color

Healthy gingiva usually has a color that has been described as "coral pink." Other colors like red, white, and blue can signify inflammation (gingivitis) or pathology. Although the text book color of gingiva is "coral pink", normal racial pigmentation makes the gingiva appear darker. Because the color of gingiva varies due to racial pigmentation, uniformity of color is more important than the underlying color itself.

Contour

Healthy gingiva has a smooth arcuate or scalloped appearance around each tooth. Healthy gingiva fills and fits each interdental space, unlike the swollen gingiva papilla seen in gingivitis or the empty interdental embrasure seen in periodontal disease. Healthy gums hold tight to each tooth in that the gingival surface narrows to "knife-edge" thin at the free gingival margin. On the other hand, inflamed gums have a "puffy" or "rolled" margin.

Texture

Healthy gingiva has a firm texture that is resistant to movement, and the surface texture often exhibits surface stippling. Unhealthy gingiva, on the other hand, is often swollen and mushy. Healthy gingiva has an orange-peel like texture to it.

Reaction to disturbance

Healthy gums usually have no reaction to normal disturbance such as brushing or periodontal probing. Unhealthy gums on the other hand will show bleeding on probing (BOP) and/or purulent exudate (pus).

Additional images

• 

  Mouth (oral cavity)

• 

  Mouth

See also

• Gum graft
• Head and neck anatomy
• Periodontitis

References

1. ^ Gingival Recession - Causes and treatment JADA, Vol 138. http://jada.ada.org. Oct 2007. American Dental Association
2. ^ ^{a b c d e} mexicodentaldirectory.com > dental sensitivity Retrieved on August 2010
3. ^ Mondofacto medical dictionary > gingival retraction 05 Mar 2000

External links

• Periodontal disease

Further reading

• Willmann, Donald. PERI 5081 - Freshman Periodontics. UTHSCSA, 2006. 2.3.1